Magnetic resonance imaging (MRI) with targeted prostate biopsy added to systematic biopsy for men on active surveillance for low-risk prostate cancer (PCa) does not significantly increase the upgrading rate on confirmatory biopsy compared with systematic biopsy alone, according to a new study.

The finding is from a prospective multicenter trial in which investigators led by Laurence Klotz, MD, of Sunnybrook Health Sciences Centre in Toronto, randomly assigned 273 men diagnosed with grade group (GG) 1 PCa to undergo confirmatory 12-core systematic biopsy or MRI with targeted biopsy in addition to 12-core systematic biopsy. The primary end point was the proportion of men upgraded to GG 2 or higher cancer.

At the time of confirmatory biopsy, 23% of patients in the systematic biopsy group and 21% of those in the MRI group were upgraded to GG 2 cancer or higher, Dr Klotz and his colleagues reported online ahead of print in European Urology.

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Systematic and targeted biopsies missed significant cancers in 6% and 8% of patients, respectively.

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“In patients with a higher risk of significant cancer based on clinical parameters, systematic biopsy should be performed even if the MRI is negative,” the authors wrote. “Our data also suggests that high-risk patients with a positive MRI should have both systematic and targeted biopsies.”


Klotz L, Loblaw A, Sugar L, et al. Active Survival Magnetic Resonance Imaging Study (ASIST): Results of a randomized multicenter prospective trial. Eur Urol. 2018; published online ahead of print.